Understanding the Work of Intensive Care Nurses: a Time and Motion Study

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Abstract

Internationally and nationally it is recognised that there is a shortage of Registered Nurses (RNs), which is occurring within a context of increasing costs of health care and limited funding. The specialist area of the Intensive Care Unit (ICU) is one area that requires numerous resources. The patients admitted to ICU need advanced specialist care involving significant human resources (nursing, medical, allied health) and equipment. One method that is utilised to manage the ICU nurse resource is workload tools. Workload tools guide manager’s decisions related to the allocation of ICU nurses. In order to develop workload tools that are applicable to the Australian context, it is important to first understand what the Australian ICU nurse does as they work.
The aim of this study was to describe and analyse ICU nurses’ activities during the day shift. A non participant time and motion observation method was utilised. Ten ICU nurses were observed for their day shift in a private hospital in South East Queensland. First, the number of activities undertaken was analysed to determine the frequency of undertaking multiple activities at one time. Next, the data were categorised into four major and 25 minor work activity categories. The major categories were direct patient care, indirect patient care, unit related activities and personal activities. Finally, the observed nurses’ activities were classified according to a schema of six work activities. This schema included ‘routineness’, ‘discretion’, ‘intensity’, ‘multiplicity’, ‘complexity’ and ‘accessibility’. Data analysis was performed using Microsoft Excel and Statistical Package for Social Sciences.
The ten ICU nurses were observed for 76 hours 26 minutes. In total 3,081 activities were observed. The ICU nurses were observed performing two simultaneous activities for 43% of their time. The major work activity categories data indicated that the ICU nurses’ time was divided up into direct nursing care activities (60.3%), indirect nursing activities (32%), personal activities (4.5%) and unit-related activities (3.2%). The schema of work activity findings indicated that the ICU nurses’ activities were predominantly ‘routine’ (94.2%), versus ‘non-routine’, requiring ‘discretion’ for 95.8% of their work activities. The ‘discretion’ category indicating the autonomy of the ICU nurse as they worked. In total, 95.6% of activities were ‘not intense’, and 41.2% of them required multiple activities (‘multiplicity’). A total of 25.2% of the work activities that were ‘complex’ and 94.9% required nurses to use their knowledge as they worked (‘accessibility’).
This study identified that the ICU nurses spent approximately two thirds of their time involved in direct nursing care and almost a third of their time involved in indirect nursing care. The simultaneous activities that ICU nurses performed equated to greater than 40% of their time. The actions of the ICU nurses were predominantly routine, autonomous and not intense. The work activities were principally regular, however there were complicating factors for this group of ICU nurses, such as multiple and complex activities. This level of analysis of ICU nurses’ work is not commonly undertaken, yet it provides valuable information that can be used to inform workforce planning.
It is recommended that the development of workload tools in the Australian context should consider the broad complex nature of providing care for the ICU patient to capture potential workload for the ICU nurses. Research into the frequency with which ICU nurses undertake simultaneous activities suggest that without adequate concentration, errors may occur. Future research exploring the work undertaken during all shifts utilising time and motion observations and the schema of work activities would provide a broader contextual view of their work. The schema of work activities has been adapted and employed for the first time in the ICU environment. Future studies utilising the schema of work activities will provide a comparison and critique of the categorisation of the ICU nurse work activities. Allocation of time for specific direct nursing activities alone does not consider other activities that nurses undertake nor does it consider the complexity of these activities.